Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
J Pediatr. 2024 Jun;269:113976. doi: 10.1016/j.jpeds.2024.113976. Epub 2024 Feb 23.
To describe the prevalence of and between-center variations in care practices and clinical outcomes of moderate and late preterm infants (MLPIs) admitted to tertiary Canadian neonatal intensive care units (NICUs).
This was a retrospective cohort study including infants born at 32 through 36 weeks of gestation and admitted to 25 NICUs participating in the Canadian Neonatal Network between 2015 and 2020. Patient characteristics, process measures represented by care practices, and outcome measures represented by clinical in-hospital and discharge outcomes were reported by gestational age weeks. NICUs were compared using indirect standardization after adjustment for patient characteristics.
Among 25 669 infants (17% of MLPIs born in Canada during the study period) included, 45% received deferred cord clamping, 7% had admission hypothermia, 47% received noninvasive respiratory support, 11% received mechanical ventilation, 8% received surfactant, 40% received antibiotics in the first 3 days, 4% did not receive feeding in the first 2 days, and 77% had vascular access. Mortality, early-onset sepsis, late-onset sepsis, or necrotizing enterocolitis occurred in <1% of the study cohort. Median (IQR) length of stay was 14 (9-21) days among infants discharged home from the admission hospital and 5 (3-9) days among infants transferred to community hospitals. Among infants discharged home, 33% were discharged on exclusive breastmilk and 75% on any breastmilk. There were significant variations between NICUs in all process and outcome measures.
Care practices and outcomes of MLPIs varied significantly between Canadian NICUs. Standardization of process and outcome quality measures for this population will enable benchmarking and research, facilitating systemwide improvements.
描述加拿大三级新生儿重症监护病房（NICU）收治的中度和晚期早产儿（MLPI）的护理实践和临床结局的流行情况以及各中心之间的差异。
这是一项回顾性队列研究，纳入了 2015 年至 2020 年间在加拿大新生儿网络参与的 25 家 NICU 中出生于 32 至 36 孕周的婴儿。根据胎龄周数报告患者特征、以护理实践为代表的过程指标以及以临床住院和出院结局为代表的结局指标。在调整患者特征后，通过间接标准化对各 NICU 进行比较。
在纳入的 25 669 名婴儿中（研究期间加拿大出生的 MLPIs 占 17%），45%的婴儿接受了延迟结扎脐带，7%的婴儿入院时体温过低，47%的婴儿接受了无创性呼吸支持，11%的婴儿接受了机械通气，8%的婴儿接受了表面活性剂，40%的婴儿在前 3 天内接受了抗生素治疗，4%的婴儿在前 2 天内未接受喂养，77%的婴儿建立了血管通路。研究队列中<1%的婴儿发生了死亡率、早发性败血症、晚发性败血症或坏死性小肠结肠炎。从入院医院出院的婴儿中，中位数（IQR）住院时间为 14（9-21）天，转移至社区医院的婴儿为 5（3-9）天。出院回家的婴儿中，33%的婴儿接受纯母乳喂养，75%的婴儿接受任何形式的母乳喂养。所有过程和结局指标在各 NICU 之间均存在显著差异。
加拿大各 NICU 之间的 MPLI 护理实践和结局存在显著差异。为该人群制定过程和结局质量指标的标准化将能够进行基准测试和研究，从而促进整个系统的改进。
